1. Our Pledge Regarding Health Information
We know your health information is private and personal. We keep a clinical record so we can give you high‑quality care and meet legal requirements. By law we must:
- keep any Protected Health Information (“PHI”) that identifies you confidential;
- give you this notice of our legal duties and privacy practices; and
- follow the terms in the most current version of this notice.
We may change this notice at any time. New terms apply to all information we already have about you. A current copy is always available on our website, in our office, or by request.
2. Who We Are & Where We Work
Polaris Psychology, PLLC (“Polaris,” “we,” “our,” “us”) is a self‑pay psychology practice based in Milford, New Hampshire. We serve clients physically located in New Hampshire, New York, and PSYPACT states or territories. Services are delivered only through secure, HIPAA‑compliant platforms for scheduling, billing, video sessions, email, and text messaging.
3. How We May Use or Disclose Your PHI
a. Treatment, Payment, and Health‑Care Operations (No Authorization Needed)
Federal rules let health‑care providers use or share PHI without written authorization when doing their own treatment, payment, or health‑care operations. Examples include:
Treatment – coordinating care, consulting with another clinician, or making a referral. Because clinicians need the full picture to provide safe care, treatment disclosures are not restricted to “minimum necessary.”
Payment – sending invoices to you, processing your credit‑card payment, or verifying out‑of‑network benefits when you ask.
Operations – quality improvement, peer review, complying with audits, cybersecurity, or training staff.
b. Other Uses and Disclosures Allowed or Required by Law (No Authorization Needed)
Subject to strict limits, we may disclose PHI without your written permission to:
comply with federal or state law, court orders, or subpoenas (after trying to give you notice or seek a protective order);
report suspected child, elder, or dependent‑adult abuse;
avert a serious and imminent threat to you or others;
assist health‑oversight agencies with audits or investigations (only as required by law);
cooperate with law‑enforcement in limited circumstances (e.g., crimes on our premises);
respond to coroners or medical examiners (only as required by law);
support workers’‑compensation claims (only as required by law);
perform approved clinical research (with privacy safeguards);
carry out specialized government functions such as national‑security or military missions (only as required by law);
send appointment reminders or tell you about treatment alternatives or related benefits.
c. Uses and Disclosures Requiring an Opportunity to Object
With your consent, we may share PHI with a family member, friend, or other person you identify as involved in your care or payment. In an emergency we may share relevant information and give you the chance to object later.
4. Uses and Disclosures Requiring Your Written Authorization
Psychotherapy Notes – We keep separate “psychotherapy notes” as defined in 45 C.F.R. § 164.501. We will not use or disclose those notes unless you authorize it except for: our own treatment; training or supervision; self‑defense in a legal action you bring; HHS compliance reviews; or as otherwise required by law.
Marketing – We do not use or disclose PHI for marketing.
Sale of PHI – We never sell your PHI.
Any other purposes – Any use or disclosure not listed in this notice needs your signed Authorization. You may revoke an Authorization at any time in writing, and we will stop future uses.
5. Your Rights
- The Right to Request Limits on Uses and Disclosures of Your PHI.
You have the right to ask me not to use or disclose certain PHI for treatment, payment, or health care operations purposes. I am not required to agree to your request, and I may say “no” if I believe it would affect your health care. - The Right to Request Restrictions for Out-of-Pocket Expenses Paid for In Full.
You have the right to request restrictions on disclosures of your PHI to health plans for payment or health care operations purposes if the PHI pertains solely to a health care item or a health care service that you have paid for out-of-pocket in full. - The Right to Choose How We Send PHI to You.
You have the right to ask me to contact you in a specific way (for example, home or office phone) or to send mail to a different address, and I will agree to all reasonable requests. - The Right to See and Get Copies of Your PHI.
Other than “psychotherapy notes,” you have the right to get an electronic or paper copy of your medical record and other information that I have about you. I will provide you with a copy of your record, or a summary of it, if you agree to receive a summary, within 30 days of receiving your written request, and I may charge a reasonable, cost based fee for doing so. - The Right to Get a List of the Disclosures We Have Made.
You have the right to request a list of instances in which I have disclosed your PHI for purposes other than treatment, payment, or health care operations, or for which you provided me with an Authorization. I will respond to your request for an accounting of disclosures within 60 days of receiving your request. The list I will give you will include disclosures made in the last six years unless you request a shorter time. I will provide the list to you at no charge, but if you make more than one request in the same year, I will charge you a reasonable cost based fee for each additional request. - The Right to Correct or Update Your PHI.
If you believe that there is a mistake in your PHI, or that a piece of important information is missing from your PHI, you have the right to request that I correct the existing information or add the missing information. I may say “no” to your request, but I will tell you why in writing within 60 days of receiving your request. - The Right to Get a Paper or Electronic Copy of this Notice.
You have the right get a paper copy of this Notice, and you have the right to get a copy of this notice by e-mail. And, even if you have agreed to receive this Notice via e-mail, you also have the right to request a paper copy of it.
6. Security Measures
- All clinical data is stored in an encrypted, HIPAA‑certified Electronic Health Record (EHR).
- Data in transit is protected by TLS/SSL encryption; data at rest is encrypted with AES‑256.
- Staff access is role‑based, password‑protected, and secured with multi‑factor authentication.
- We keep audit logs, perform annual risk assessments, and maintain an incident‑response plan.
- Every vendor who might handle PHI signs a Business Associate Agreement (“BAA”) and completes security vetting.
7. Information We Collect That Is Not PHI
When you browse our public website pages we (or third‑party partners) collect:
IP address, device type, browser, and pages visited;
cookie identifiers placed by Google Analytics and Google Ads;
form‑field data you voluntarily submit (name, phone, email, message).
We use this information to secure the Site, understand traffic, and measure the effectiveness of our outreach. It is never merged with your clinical record, and we do not sell it.
8. Google Ads & Google Analytics
We use these services to show ads and to learn how visitors use our Site. Google places cookies or similar tracking technologies on your device to: count visits, see which ads or search terms led you to us, and compile non‑identifiable demographic statistics.
Your choices: adjust your browser to block or delete cookies, use Google’s Ad Settings, or install the Google Analytics Opt‑out Browser Add‑on. Refusing cookies will not limit your ability to receive services.
9. SMS/Text Messaging Terms (A2P 10DLC‑Compliant)
Opt‑in – By giving your mobile number you consent to receive scheduling, billing, or clinical‑coordination texts.
Frequency – varies per interaction.
Rates – Standard carrier message/data rates apply.
STOP/HELP – Reply STOP to cancel, HELP for help.
No sharing for Marketing/Promotional Purposes – Mobile information will not be shared with third parties or affiliates for marketing/promotional purposes. Information sharing to subcontractors in support services (e.g., customer support, SMS platform) is permitted and kept confidential.
Our SMS platform – you may receive email and SMS reminders to be notified about upcoming bookings. These emails and SMS are sent using our service provider Twilio. You agree that we may share your mobile phone number and the contents of any message you send or receive through such Service with our third-party partner, Twilio. For more information regarding how Twilio may store or use your information, please review Twilio’s Privacy Policy which can be found here: https://www.twilio.com/legal/privacy.
10. Third‑Party Service Providers
We rely on carefully screened vendors (EHR, video platform, payment gateway, scheduling tool, secure email, SMS gateway, cloud hosting). Each vendor signs a BAA when PHI is involved, provides proof of encryption, access controls, and incident‑response policies, and is reviewed at least yearly. We never rent or sell any client information—clinical or non‑clinical.
11. No Medical Advice on This Site
Content on polaris‑psychology.com is for general information only. It is not medical, psychological, or legal advice and is not a substitute for professional treatment. Always seek the advice of a qualified provider with questions about a condition.
12. Children’s Privacy
We do not knowingly collect personal information from children under 13 on public Site pages. Clinical services for minors are provided only with verified parent/guardian consent in compliance with HIPAA and applicable state laws.
13. Limitation of Liability
We use commercially reasonable safeguards, but no method of transmission or storage is 100 % secure. By using the Site or our services you acknowledge that Polaris Psychology, PLLC and its clinicians are not liable for indirect, incidental, or consequential damages arising from unauthorized access, disclosure, alteration, or destruction of information except as required by law.
14. How to Contact Us
Polaris Psychology, PLLC
52 Nashua Street, Suite 19, Milford, NH 03055
Phone: (800) 240‑5716 | Email: privacy@polaris‑psychology.com
You may also file a complaint with the Office for Civil Rights, U.S. Department of Health & Human Services. We will not retaliate.
15. Change Log
- June 1 2021 – Original publication.
- May 6 2025 – Added Google Ads/Analytics disclosure; included A2P 10DLC SMS terms; clarified vendor vetting